Loading...
HomeMy WebLinkAboutNCC191347_NOI Application_20190813Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 8/12/2019 4:09:48 PM (NCG01 NOI Submission) Approve by McCoy, Suzanne 8/13/2019 8:14:31 AM (Review- Construction NOI 14749) • The task was assigned to McCoy, Suzanne by round robin distribution 8/12/2019 4:10 PM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 14, 2019 5:00 PM 8/12/2019 4:10 PM Submit by McCoy, Suzanne 8/13/2019 8:15:32 AM (Payment Verification for NCC191347) • McCoy, Suzanne assigned the task to McCoy, Suzanne 8/13/2019 8:15 AM • The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 27, 2019 5:00 PM 8/13/2019 8:14 AM STME NORTH CAROLINA Ernvlronmentol qualily A. Project Information Part A. Project Location and Waterbody Inforrration 1. Project Name * Heritage Vet Clinic 2. County* Wake 3. Highway or Street 3240 Rogers Rd Address * Street name only is acceptable if no address nurrtrer assigned yet 4. City or Township* Wake Forest 5. State * NC 1r-i)iTiT7i)ilf1Iif_TiIa10141 6. Zip Code* 27587 7. Latitude * Enter the latitude in decirral degrees 35.9490 8. Longitude * Enter the longitude in decirral degrees (MIST be negative) -78.5170 If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of North Carolina. Look for the coordinates in the bottom left corner. 9. Date to Begin* 08/19/2019 Estimated Construction Project Start Date 10. Date to End* 05/25/2020 Estimated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 2.12 disturbed* (including off -site borrow and waste areas) 13. Total site area 2.12 (acres)* 14. Post- 0.48 construction (Estimated) impervious area (acres) * NCC Project NCC-WAKE-2019-Heritage Vet Clinic Tracking ID Assigned autorratically Below you must enter waterbody information for surface waters affected by this project. Please consult DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. You may enter up to 3 waterbodies. 15a. Receiving Smith Creek Wate rbody* Narre of waterbody into which stormuater runoff will discharge 15b. Waterbody 27-23-(2) Index No. * NCWaterbody Index Number Stormwater V No discharges will flow r Yes to additional wate rs * 16a. Is this project r Yes subject to the NC r No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. Perrrittee Information - Legally Responsible Entity and Individual ..................................................................................................................................................................... h Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same organization. That person must be a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Organization G&G Builders Name * 2. First Name* Amos If Corporation, enter Registered Agent First l\b e 3. Last Name * Greene If Corporation, enter Registered Agent Last Barre 3b. Title VP 4. Permitee E-mail amos@ggbuildersnc.com Address* 5. Permittee 9193657488 Telephone No.* 6. Permittee Mailing Street Address Address* 1603 South Hollybrook Road Address Line 2 1603 S. Hollybrook Road City State / Province / Region Wendell NC Postal / Zip Code Country 27591-8428 us Check box if the r% Yes street address the same as mailing address 7. Permittee Street Street Address Address* 1603 South Hollybrook Road Address Line 2 1603 S. Hollybrook Road City State / Province / Region Wendell NC Postal / Zip Code Country 27591-8428 us C. Site Contact Information Part C. Roiect Site Contact hforrration 1. Type of Individual Ownership* 2. Primary Site Amos Contact - First Name * 3. Primary Site Greene Contact - Last Name * 4. Title VP 5. Site Contact E- amos@ggbuildersnc.com mail Address* 6. Site Contact 9193657488 Telephone No.* 7. Organization G&G Builders Name 8. Site Contact Street Address Mailing Address* 1603 S. Hollybrook Road Address Line 2 city Wendell Fbstal / Zip Code 27591 State / Province / Region NC Country United States D. E&SC Plan Part D. Erosion & Sediment Control (E&SC) Ran Approval Information ....................................................................................................................................................................................................................................... 1. Date E&SC Plan 08/01/2019 Approved * 2. E&SC Plan Project 2019-00000910 Number/ID* Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by r Local Program 4. Local Program* Town of Wake Forest Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. 5. E&SC Plan Land Disturbing Permit.pdf Approval Mist be R7Fformat letter/documentation 6. NOI Certification CCF08052019_00004.pdf Form Mist be RDFformat This is an Express r No Review Project* r Yes 931.27KB 386.44KB E. Certification North Carolina General Statute 143-215.613 (1) provides that: Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: rJ I am the person responsible for the construction activities of this project, for satisfying the requirements of this permit, and for any civil or criminal penalties incurred due to violations of this permit. * V The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information. * I7 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * V If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit, I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * I7 I hereby request coverage under the NCG010000 General Permit and understand that coverage under this permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an individual permit. Specify if you are:* r The Responsible Person named on this Notice of Intent r Authorized Responsible Person* Important: The person who signs this Certification above and signs the NOI Certification Form should be the same person (or authorized responsible person within the same organization) as listed in Section B (Permittee Information) of this form. *An authorized individual is a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. Signature Type Name* Amos Greene Title Vice President Organization G&G Builders Date * 08/12/2019 F. Tracking and COC Info NOI Tracking No. 14749 NC Reference No. NCG01-2019-1347 Uses 'count number variable (incremrented by SP) Certificate of NCC191347 Coverage (COC) Uses'count_nunber'variable (incremrented by SF) No. * Count Number 1347 Sequential nunber for subrrittal that is incremented by Stored Procedure COC Year 2019 Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)